Background

Compliance and concordance remain important issues in the management of Coronary Heart Disease (CHD) and have implications for medicines education strategies in Cardiac Rehabilitation (CR). A qualitative study1 of the effect of information provided to patients after heart attack found that compliance with lifestyle modification decreased over time and some patients who were interviewed again some months later questioned its relevance. Compliance with statin therapy, for example, has been found to substantially reduce over time2 and a recent qualitative study found that compliance with statins appeared to be associated with the medicines education provided and patients' health beliefs2. However previous qualitative studies have not specifically explored changes over time of CR patients' perspectives on use of medicines. Therefore this qualitative study aims to follow a group of CR patients over time and explore their perspectives on compliance and concordance with medicines.

Method

To date in-depth, audiotaped interviews have been conducted with 10 CR patients, some with a carer present. Interview topics included experiences of CHD, experiences with medicines, sources of medicines information and education and experiences of pharmacists. Transcripts were analysed by constant comparison. More women will be recruited to redress previous under-representation and all patients will be interviewed again one year after their heart attack to explore changes in perspectives on compliance and concordance with medicines.

Results

Emerging themes from interim results indicate that CHD was seen only in the context of having had a heart attack; symptoms of heart attack were often incorrectly identified and health beliefs affected perception of future risk. The CR programme was viewed as primarily being about exercise, although it also provided social support. Medicines were viewed as helping to prevent further heart attacks and all patients demonstrated a positive attitude towards compliance with medicines, although ACE inhibitor induced cough emerged as a significant side effect. Patients wanted to know about their medicines but in terms that they understood. Written information was the most common source of medicines information and various health professionals provided information and education verbally. Some patients recalled information and education given by pharmacists and one patient had actively sought information from pharmacists. However pharmacists were criticised for not offering enough information about side effects.

Discussion

Many of these findings are supported by previous qualitative research in CHD1,3,4. These interim results suggest that these patients are compliant with medicines at the time of the CR programme, which varies from six weeks to 3 months after discharge from hospital. However, these are interim results that will be substantially developed with further research.

References

1. Wiles R. Patient's perceptions of their heart attack and recovery: the influence of epidemiological "evidence" and personal experience. Soc Sci Med 1988; 46: 1477-1486.
2. Tolmie E, Lindsay G, Kerr S, Brown M, Ford I, Gaw A. Patients' perspectives on statin therapy for treatment of hypercholesterolaemia: a qualitative study. Eur J Cardiovasc Nurs 2003; 2: 141-149.
3. Bergman E, Bertero C. You can do it if you set your mind to it: a qualitative study of patients with coronary artery disease. J Adv Nurs 2001; 36: 733-741.
4. Ruston A, Clayton J, Calnan M. Patients' action during their cardiac event: qualitative study exploring differences and modifiable factors. Br Med J 1998; 316: 1060-1065.